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Impact of highly active antiretroviral therapy (HAART) on clinical outcomes of vertically HIV-1 infected children
© Palladino et al.; licensee BioMed Central Ltd. 2008
Published: 9 April 2008
The use of antiretroviral therapy produced a decrease in morbidity and mortality rates in human immunodeficiency virus type 1 (HIV-1)-infected children.
To update a previous epidemiological survey that demonstrated the benefits of HAART on the clinical outcome of HIV-1 vertically infected children.
Materials and methods
We carried out a retrospective observational survey involving 346 HIV-1 vertically infected children (≤17 years old) living in the Autonomic Community of Madrid. The analysis was stratified in 5 calendar periods (CP) on the basis of the changing antiretroviral treatment protocols: CP1 (80-89): not treatment was used in this period; CP2 (90-93): the standard of care was monotherapy with nucleoside analogue reverse-transcriptase inhibitor (NRTI); CP3 (94-96): when dual-NRTI therapy was administered; CP4 (97-98): the antiretroviral regiments was HAART with a combinations of three or more drugs; CP5 (99-06): when > 60% of children were on HAART and less than 10% were untreated. We assumed that vertical transmission occurred on the birth day. We calculated the mean CD4+ T cells count and log10 viral load per year, and we studied their trend over time. Then, we estimated the Kaplan-Meier curve to analyze the occurrence of AIDS and death. Finally, we performed a Cox regression analysis to calculate the relative risk (RR) for absence of AIDS and survival.
We observed an increase of the mean CD4+ T-cell percentage and a concomitant decrease of the plasma log10 viral load since 1997. A total of 205 kids had a diagnosis of AIDS (59.2%) and 122 died (35.3%). The last two periods (CP4 and CP5) had significantly fewer AIDS cases compared to the previous (P<0.001); in particular, the relative risk of the CP5 compared to the CP1 was of 5.5 (95%CI: 3.60-8.51). In the CP5 there were less death cases compared with the other periods (P<0.01) and the RR was of 9.7 (95%CI: 3.49-27.2) compared to the CP1, when the event of death occurred in more than the 20% of the children.
We confirmed the benefits of HAART in reducing adverse clinical outcomes as AIDS and death in HIV-1 vertically infected children in our cohort of kids living in the Autonomic Community of Madrid.
The abstract is being presented on the behalf of the Spanish Group of Pediatric HIV Infection.
This article is published under license to BioMed Central Ltd.